Anaphylaxis

Question 1

A 32 year old woman is brought in by ambulance having been stung by a bee 20 minutes previously. She rapidly became short of breath and when the ambulance arrived she suffered a syncopal attack. How would you assess and manage her?

Answer 1

Impression
Syncope in the setting of distributive shock secondary to anaphylaxis.

DDx
Forms of shock:
- cardiogenic
- obstructive: PE, 
- distributive: neurogenic, septic, anaphylaxis
- hypovolaemic
DDx for syncopal episode
- neuro vs cardio vs BP
- exclude vertiginous

Goals

• Likely anaphylaxis, therefore call for senior help, begin A to E and start empirical treatment for anaphylaxis with adrenaline IM/IV infusion
• concurrent Hx/Ex/Ix to rule out DDx

Question 2

Anaphylaxis - Assessment

Answer 2

Assessment:
- call for senior help

A - patent maintaining, auscultate for degree of stridor, widespread wheeze, intubate pending GCS, remove allergen.
B - RR/SP02, administer supplemental 02 as required. Consider nebulised adrenaline
C - IV access, initial bloods (VBG, FBC, CRP/ESR). start fluid bolus of 1L then continuous infusion to maintain appropriate BP. IV infusion
D - GCS

Anaphylaxis management

• IM adrenaline 0.5mL of 1:1000 until IV access
• then infusion of 1:10000 adrenaline at 5mL/hr
• consider systemic antihistamines; only for sympotatic treatment of skin pruritus
• administer IMs every 5 minutes if no response
• if non-remitting then ICU/retrieval, intubation if significant airway obstruction and ongoing instability

Question 3

Anaphylaxis - history

Answer 3

History

• PC: acute onset skin/resp/GI sx,
• sx: urticarial rash, stridor, dyspnoea, GIT upset (N/V)
• exposure to known allergen
• RISKS: previous anaphylaxis, anaphylaxis management plan?
• PMHx, PSHx, allergies, medications
• SNAP

Question 4

Anaphylaxis - Examination

Answer 4

Examination

• as per A to E
• Gener